DMOS: Ankle Sprains in Athletes

By Julie Grundberg, Des Moines Orthopaedic Surgeons

Ankle sprains are a common injury encountered in a podiatry practice. Sports are often the cause of ankle injuries, yet occupational ankle sprains are also common. Approximately 7-10% of all emergency room visits each year is the result of ankle injuries. Eighty-five percent of ankle injuries are sprains.

Inversion ankle sprains occur when the leg is perpendicular to the ground and the foot is forced toward the midline of the body. The lateral (outside) ankle consists of three ligaments working together to prevent inversion strain. The most commonly injured ligament is the ATFL (anterior talofibular ligament). It originates at the tip of the fibula and courses to the dorsal (top) midfoot. The CFL (calcaneofibular ligament) is injured when a higher degree of inversion stress is applied to the ankle. The ATFL is usually injured with the CFL and part of the ankle joint capsule. The PTFL (posterior talofibular ligament) is the strongest ligament and is rarely injured.

The most common grading system for ligamentous injuries is the three-grade system. Grade I involves stretching of a ligament without tearing or instability. Grade II is a partial tear with mild to moderate instability. Grade III is complete rupture with marked instability.

Anyone with an ankle sprain who is evaluated by a physician deserves to have ankle and possible foot radiological examination. This is an absolute if the patient is unable to weight-bear and/or swelling and ecchymosis are present. There are six areas that a fracture may occur with an inversion ankle injury: 1) distal fibula 2) distal tibia 3) ankle mortise/syndesmosis 4) base of the fifth metatarsal 5) anterior beak of the calcaneus and 6) talar dome.

Most grade I sprains are successfully treated conservatively with RICE (rest, ice, compression and elevation). Grade II may need immobilization with a cam walker. Grade III usually requires a non-weight bearing below the knee cast and rarely patients require surgical reconstruction of the lateral ankle ligaments.

Neglecting treatment of an ankle sprain can lead to chronic low grade complaints of pain, reoccurring injuries, more time out of competition/activities, more expensive testing such as a MRI, and the development of ankle instability also know as a “chronic sprainer”. This syndrome causes the ankle to continually give way. This can occur if the ligaments do not heal properly and the peroneal tendons weaken, causing a proprioceptive defect. A proprioceptive defect occurs when damage to the nerves within the ligaments causes an unstable feeling ankle, leading to decreased ankle control and further sprains. Commonly, physical therapy rehabilitation includes strengthening and ankle proprioceptive training.

In my experience ankle sprains can be benign injury with a grade I sprain and early return to work and recovery. Often grade II and III are UNDER treated and this does lead to more morbidity, time off competition/activities, chronic complaints, pain and symptoms. Aggressive treatment for a “simple” sprain can shorten recovery time and result in a pain free patient.

Dr. Julie Grundberg is a Podiatrist at Des Moines Orthopaedic Surgeons, P.C. Dr. Grundberg specializes in Foot and Ankle care and surgery, including sports injuries. She is available to see patients at DMOS East, offering satellite services at DMOS – West one day per week. To reach Dr. Grundberg or to schedule an appointment, please call (515) 299-6366.